The fake Viagra tablets that are linked to stroke, liver failure and even death: How herbal supplements 'taken by Lamar Odom' have shocked health regulators for years

The potentially deadly effects of herbal Viagra like that apparently taken by basketball star Lamar Odom before he suffered heart failure have concerned health regulators for years.

The former LA Lakers player, 35, is fighting for his life after reportedly taking up to ten tablets of the performance-enhancing supplement.

A source at Sunrise Hospital in Las Vegas where Odom is currently being treated for what has been described as a non-suicidal drug overdose revealed to E! News this morning that doctors found 'virtually every drug imaginable' in his system, including cocaine and opiates, and that he is believed to have suffered a stroke and ‘choked on his mucus.’

Odom's condition has once again thrown the spotlight on the shady world of erectile dysfunction products that have long been linked to reports of stroke, kidney failure, liver injury and even death.

In its latest warning just two weeks ago, the U.S. Food and Drug Administration (FDA) said it had found 300 herbal products that contained hidden ingredients including prescription drugs like Viagra and Cialis.

One product contained 31 times the prescription dose of tadalafil, the active ingredient in Cialis.

These ingredients work by encouraging blood flow to the sexual organs, which, the FDA warns, could be deadly for some, particularly those who take medication for high blood pressure and diabetes.

M. Daniel Dos Santos, of the FDA's Division of Dietary Supplement Programs, said in this month's report: 'A doctor needs to evaluate your total medical condition to know whether a particular medication is safe for you to use.

'Consumers have no way of knowing which drugs or ingredients are actually in the product just by reading the ingredients on the label.'

From 2007 to 2010, the FDA also pressured companies to recall nearly 200 inappropriately formulated products which were linked to reports of stroke, kidney failure, liver injury and death.

In 2008, four men died and seven others suffered severe brain damage after taking counterfeit Viagra in Singapore.

In 2011, the FDA warned of the dangers of a herbal product called ExtenZe, which resembled the real ExtenZe pills in every way expect for the added prescription-only chemicals tadalafil and sildenafil.

Both these active ingredients are in Cialis and Viagra and both drugs require a doctor's prescription.

It was the latest in a string of cases where real drugs for erectile dysfunction and other conditions appeared in herbal supplements that were marketed to treat those conditions.

In February of that year, Biotab voluntarily recalled two lots of counterfeit ExtenZe that contained tadalafil, sildenafil and sibutramine, a weight-loss pill that is not approved for sale in the U.S.

At the time, Biotab said that other counterfeit products might still be on store shelves.

Ilisa Bernstein, deputy director of the Office of Compliance in the FDA's Center for Drug Evaluation and Research said at the time: 'This incident is an example of a growing trend of products marketed as dietary supplements or conventional foods with hidden drugs and chemicals.

'These types of products are typically promoted for sexual enhancement, weight loss, and body building, and are often represented as being "all natural."

'Consumers should exercise caution before purchasing products promoted for these uses.'

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Anesthesia Awareness

Duke University Scool of Medicine
Duke Anesthesiology

When the movie “Awake” came out in theaters it sparked much controversy throughout the country about the condition also known as anesthesia awareness. Following the release of the movie, Larry King Live did a special about this issue, in which King interviewed physicians and patients who have suffered from awareness. In response to the recent influx in publicity over the issue, the DREAM Campaign has taken the initiative to interview Dr. Tong Joo (TJ) Gan, who sheds light on many concerns that patients have when considering a surgical procedure as well as the misconceptions about anesthesiology in general. With so much focus on awareness and the negative impacts of anesthesia, it is important that the public be properly informed. Awareness can be a highly unpleasant experience, but most times the alternative is a surgery with negative outcomes or even worse, death.

There are about 100 to 150 reported cases of anesthesia awareness per year in the United States. It is very difficult to get an exact figure because it is under reported. Dr. Gan shared with us a case in which a patient of his experienced anesthesia awareness. The patient had come to the Emergency Room with a gunshot wound to the abdomen. He was suffering from massive blood loss and had very faint blood pressure so the anesthesiologist had to administer a safe dosage of anesthesia that would not hinder the overall well being of the patient as well as the blood pressure. When questioned post-operatively, the patient reported that he could hear voices during a brief period in surgery.

Hearing is said to be the last sense to go and the first to return under general anesthesia. As in the case of Dr. Gan’s patient, the modifications that had to be made because of low blood pressure caused the patient to become slightly aware and that is why he was able to hear briefly during his operation. “He did not suffer from any consequences after that and in fact, he thought that it was part of the operation,” said Dr. Gan.

When asked the common question, how can a person feel pain when they are paralyzed, Dr. Gan discussed the three areas of anesthesia; paralysis which paralyzes the muscles, analgesic which block pain signals to the brain, and anesthetic which puts the person to sleep so that they do not remember anything. For this reason, a person can be physically paralyzed but they may still feel pain. The human body does have natural responses to pain such as sweating, increased blood pressure and movement which may indicate to the anesthesia care provider that they are not fully anesthetized.

New technology allows anesthesiologists to measure the brain waves of a patient even while they are under anesthesia. “By using specific monitors, one can tell how deep a person is in anesthesia,” says Dr. Gan, “It is a bit like an iceberg; if it is below the water, it is very difficult to know how deep the iceberg is, and the monitor tells you what the depth of anesthesia is even when the patient is asleep.” The Bi-spectral Index Monitor, or BIS monitor is an example of such a device. Brainwaves are measured on a range of numbers from 0 to 100 in which 0 equates no brain activity and 100 is the mental state of a person when fully awake. During general anesthesia, brainwaves are measured between 40 and 60. If the BIS monitor measures activity above 70, there is a very good chance that the patient may not be fully anesthetized.

Dr. Gan mentions several fascinating facts throughout the interview one being that genetic factors can influence the way a patient reacts to anesthesia. Studies have shown that women tend to wake up about 10 minutes sooner than men when the anesthesia is cut off. This means that women need more anesthesia in order to produce the same effect. Redheads are also said to need more as well.

The revolutionary research that is being done by researchers like Dr. Gan is vital to prevent cases of unpleasant experiences and side effects. “One of the most effective ways to try and prevent this problem is to raise awareness of this problem, no pun intended,” Dr. Gan explains, “So we educate our staff, anesthesiologists and anesthesia care providers to let them know that this problem does exist and therefore it is important to take steps as well as understand the patient to try and prevent it.” He also mentions that there are mandatory educational modules that every anesthesia care provider must take. These modules go through various aspects of educational awareness such as the incidents of awareness, the scenarios where awareness may happen, the drugs or drug combinations that would reduce the incidents of awareness as well as monitoring the inter-operative awareness.

The Department of Anesthesiology is committed to find as many ways possible to provide the best patient care. Dr. Gan’s research in particular focuses on steps that could alleviate patients from the common unpleasant side effects of anesthesia and surgery by improving patient outcomes during the perioperative (before, during and after surgery) period including anesthesia awareness, pain, nausea and vomiting, and bowel dysfunction through the use of drug and non-drug method, such as acupuncture.
Our hope is that through listening to this interview, people will become educated about the issue and in turn they will be relieved of any anxiety they may face about being under anesthesia.

Dr. Gan is a professor and devoted researcher here at Duke, whose interests include Anesthetic-related Clinical Pharmacology, Inter-operative Awareness and Post-Operative Pain, Nausea and Vomiting, and using Acupuncture. He came to Duke as a visiting associate and fellow in 1993 is now serving as both professor and Vice Chairman of Clinical Research. Dr. Gan is also known for his research on the Bi-spectral Index (BIS) Monitor.

Patient Awareness Under General Anesthesia
Lifeline to Modern Medicine

What is patient awareness under general anesthesia?
Awareness under general anesthesia is a rare condition that occurs when surgical patients can recall their surroundings or an event—sometimes even pain—related to their surgery while they were under general anesthesia.

When using other kinds of anesthesia, such as local, sedation or regional anesthesia, it is expected that patients will have some recollection of the procedure.

Studies are not conclusive on the frequency of awareness under general anesthesia, but even one case is important to anesthesia professionals (anesthesiologists and certified registered nurse anesthetists), who recognize that this can be a distressing or traumatic experience for the patient.

When awareness during general anesthesia does occur, it is usually just prior to the anesthetic completely taking effect or as the patient is emerging from anesthesia. In very few instances, it may occur during the surgery itself. Despite the rarity of awareness, members of the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) want you to know about this possibility. These organizations have been studying this issue and are in the process of evaluating the effectiveness of various technologies and techniques to decrease the likelihood of this occurring.

Why does it happen?
In some high-risk surgeries such as trauma, cardiac surgery and emergency cesarean delivery, or in situations involving patients whose condition is unstable, using a deep anesthetic may not be in the best interest of the patient. In these and other critical or emergency situations, awareness may not be completely avoidable. While the safety of anesthesia has increased markedly over the last 20 years, people may react differently to the same level or type of anesthesia. Sometimes different medications can mask important signs that anesthesia professionals monitor to help determine the depth of anesthesia. In other rare instances, technical failure or human error may contribute to unexpected episodes of awareness. The ultimate goal is always to protect the life of the patient and to make the patient as comfortable as possible. That is why it is important to have highly trained anesthesia professionals involved in your surgery.

How can it be avoided?
Before surgery, patients should meet with their anesthesia professional to discuss anesthesia options. Should there be concerns regarding awareness, this is an ideal time to express them and to ask questions. Patients should share with their anesthesia professional any problems they may have experienced with previous anesthetics, and also discuss any prescription medications or over-the-counter medications they are taking.

As always, your anesthesia professional will guide you safely through your surgery by relying on his or her clinical experience, training and judgment combined with proven technology.

What You Should Know About Patient Awareness Under General Anesthesia
It is quite rare. When it does occur, it is often fleeting and not traumatic to the patient. Patients experiencing awareness usually do not feel any pain. Some patients may experience a feeling of pressure. Awareness can range from brief, hazy recollections to some specific awareness of your surroundings during surgery. Patients who dream during surgery, or who have some perception of their surroundings before or after surgery, may think they have experienced awareness. Such a sensation or
memory does not necessarily represent actual awareness during surgery. Experts in the field of anesthesiology are actively studying this condition and are seeking the most effective ways to prevent it. Awareness can occur in high-risk surgeries such as trauma and cardiac surgery in which the patient’s condition may not allow for a deep anesthetic to be given. In those instances, the anesthesia professional will weigh the potential for awareness against the need to guard the patient’s life or safety. The same is true during a cesarean section, particularly if it is an emergency and a deep anesthetic is not best for the mother or child.

It has been shown that early counseling after an episode of awareness can help to lessen feelings of confusion, stress or trauma associated with the experience. Researchers in anesthesiology have spearheaded developments in technology that have dramatically improved patient safety and comfort during surgery over the last 20 years. A highly trained anesthesia professional should be involved in your surgery. No technology can replace this expertise. New brain-wave monitoring devices currently being tested may prove to be helpful in reducing the risk of awareness, but they need to undergo the same rigorous scientific review process that has led to wide adoption of other medical technologies. Patients should talk with their anesthesia professional before surgery to discuss all of their concerns, including the remote possibility of awareness. These professionals work to ensure the best possible care of patients in the operating room.

Patient awareness happens very infrequently. This remote possibility should not deter you from having needed surgery. Your anesthesia professional can help you to feel comfortable and informed about your upcoming experience with anesthesia.

What does the future hold?
As patient advocates, anesthesia professionals are working hard to reduce the likelihood of awareness under general anesthesia. Depending upon the type of surgery, these experts have an array of proven technologies that can be used to monitor various vital signs of the surgical patient. Extensive research is under way to develop and study new technologies, such as brain-wave monitoring, that may lessen the risk of awareness. At the present time, none of these new technologies has been perfected.

Remember—no monitoring device can replace the judgment and skill of an anesthesia professional who has years of training and clinical experience. Working together, you and your anesthesia professional can make your anesthetic experience as safe and comfortable as possible.

What should I do if I think I have experienced awareness?
The American Society of Anesthesiologists urges you to talk with your anesthesia professional, who can explain to you the events that took place in the operating room at any stage of your surgery and why you might have been aware at certain times. It is important to note that a variety of anesthetic agents is often used, some of which may create false memories or no memory at all of the various events surrounding surgery. If you have distinct recollections of your surgery and want to discuss them, your anesthesia professional can help you or refer you to a counselor or to other appropriate resources.

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'I am open for everything': 19-year-old offers her 'virginity for sale' with $250k price tag in classifieds advert

The woman, who was described in the advert as 161cm, 44 kilos with an athletic body, appeared to have posted to classifieds site Locanto on Thursday and titled her advert 'Virgin seeks you, Sydney City' .

'Hey, I am a 19 years old girl who wants to sell her virginity,' [sic] the advert stated, before listing a series of conditions for the sale.

'We have to go to a restaurant, so we can go out for a dinner and we can meet,' it continued.

'It will happen in an hotel which you can choose. If I don't want to do this, I can rescind from the deal,' it went on.

The advert stated that 'we have to use a condom' and warned any potential buyer: 'You have to pay a prepayment, about which we can talk about.'

It was also clear there were to be 'no sex toys' and 'no violence'.

'It is not allowed to make a film of it or film the act,' it continued.

The advert ended by stating the price the woman was apparently willing to consider.

'The price is $250.000,00/250k. Send me your questions and offer. I am open for everything,' it stated.

The teen wouldn't be the first to offer her virginity to paying customers.

Last month, a German teenager put her virginity up for auction through a sinister website that boasts of having doctors who can verify the girls have not had sex.

The 18-year-old, Kim, decided to sell her body through the agency Cinderella Escorts to fund her studies, a flat and a car.

Bidding for the 5ft 8in student started at £86,640 (100,000 Euro), of which 20 percent would go to the agency, local media reported.

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I had vagina therapy with a vagina physiotherapist

I thought the recovery from my child’s birth would be easier than the birth itself. I was wrong.

My baby was born by scalpel – an episiotomy. Episiotomy, also known as perineotomy, is described as a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician during second stage of labor to quickly enlarge the opening for the baby to pass through.

I cannot put into words what it was actually like.

She was perfect, although a little bloody. I expected to be back on my feet quickly. But I was wrong, so very wrong.

Life with a newborn is not easy, even less so when you have another child or two that also needs your attention. It is even harder when you are in excruciating pain.

The constant pain was debilitating. I was unable to walk some days and was often forced to look after my two children from the floor where I crawled everywhere. When my husband came home I was an emotional and physical wreck. I was often in so much pain I had to dose myself up on medication and lay face down on the carpet next to the blanket on the floor that contained a days worth of spit up.

Even thinking about sex was hard, it was eight weeks before we gave it a go for the first time. My husband was understanding, sympathetic about the lack of sex during the first few months, and lets be honest – also very tired from helping me with the night shift. But I’m sure it was also frustrating for him.

After eight weeks I was physically healed, but mentally… not so much. It was not really painful during sex, but it sure was afterwards.

I began to become convinced that there was something seriously wrong with my vagina.

I went to the doctor and pleaded with her to try and fix me. She gave my vagina the once over and said that everything looked fine, but said that there may be some nerve damage and she would send me off to get X-rays just in case it was a broken pubic bone.

Well hell, this must be it! I thought.

My vagina is broken! Six bloody months of walking around with a broken bloody vagina. It made sense!

Then the X-ray came back all clear. Although I was convinced that they must have done it wrong, I had to accept I didn’t have a broken vagina.

There was only one more step to take and the doctor suggested a physiotherapist…. for my vagina.

So off I went to a vagina physiotherapist. To have vagina therapy.

Did you even know this was an actual job? I sure didn’t. And as I sat in the hospital waiting room looking at all of the other patients quietly waiting in wheelchairs, sitting with helpers – post car crashes and work injuries – I worried about what they might be thinking of me. Where was her injury? Why wasn’t she limping enough to notice?

I walked into the little room accompanied by the physiotherapist, an attractive smart blonde woman with shiny black flats. I really wanted to ask her right off the bat what her deal was, why vaginas? Why not feet? But I saved that for the second visit two months later when she told me that she just wanted to help women and their sexual health. She sounded legit.

The exam was similar to a doctors exam but without as many contraptions, she asked me to do a kegel (where you tighten your vagina). I did, and she looked at me quite surprised, “Hmmmmmm” she said, with her finger still wriggling around inside me.

“That’s about as strong as I have felt…” she kept wiggling. “… And the left side is VERY tight!”

Post-exam she sat me down and told me what the problem was. I had a tight vagina. Actually she used the words “I think you have a condition known as vaginismus which is a genito-pelvic pain disorder. A condition that affects a woman’s ability to engage in vaginal penetration, where your pelvic floor is tight and can spasm.”

But all I heard was “TIGHT VAGINA”.

And you know what? I smiled, looked up to the ceiling nodded my head and laughed.

This whole time I’m walking around in constant pain thinking I had broken myself when in reality it was my muscles tightening up so much on the left side that the pain radiated down my legs.

She gave me a print out with information about vaginismus. On the flip side of the page was some yoga, breathing and visualisation exercises.

I’m not really the most serious person. The printout had a diagram of a stick figure lady, legs up in the air, visualising her vagina relaxing. To this day, it’s quite possibly the most hilarious thing I have ever seen.

But I did all of the exercises. I breathed calmly like you wouldn’t believe. I visualised the hell out of my vagina getting all loose.

And it worked!

The pain subsided and I could walk around like a normal person without feeling like someone had shoved a porcupine up there.

The problem with any disorder that is caused in part by anxiety is that you are sometimes the only one that is in charge of your own recovery.

When I was diagnosed my physiotherapist had said exactly that to me:

“I have good news and bad news. The good news is that you are in charge of your own recovery. The bad news is that you are in charge of your own recovery.” Those words have stuck with me.

You can be helped along by medication and pain relief – both of which I have definitely taken. But ultimately it’s up to you. And it’s daunting to be the only one that can really fix you, but it is also empowering.

You don’t have to have a traumatic birth for you to be traumatised in some way, you don’t have to have a difficult birth in order to feel it was difficult for you. Birth is such a different experience for us all and our own experience of it and how we deal with it afterwards is unique.

Vaginismus is often triggered by childbirth but it can also be something that was always there, something that can develop in your teenage years. It can stop women from ever having sex or it can mean having painful sex frequently.

If you think you might have something similar please see your doctor as it could be a symptom of anxiety or something else.

Your sexual health is just as important as anything else in your life. I never thought I’d have vagina therapy but I’m very glad I did.

France's prime minister has raised the terrifying specter of ISIS carrying out chemical or biological weapons attacks on the West, but international investigators have so far confirmed only a single use of mustard gas by the terror gang in the Middle East.

The Organization for the Prohibition of Chemical Weapons, which enforces a global treaty, announced earlier this month that it had determined with "utmost confidence" that a "non-state actor" used the outlawed agent outside Aleppo, Syria, in August, likely killing a baby.

U.S. intelligence officials told NBC News that ISIS was the non-state actor. The OPCW is continuing to investigate other suspected uses of chemical weapons by ISIS.

ISIS trackers say its current arsenal includes weapons that are easily scavenged: mustard gas in Syria, which stockpiled hundreds of tons before agreeing to dispose of it two years ago, and chlorine that could be obtained from any water treatment facility in territory it has seized.

That seemed to be confirmed in a Tumblr post in August by high-profile ISIS fighter Israfil Yilmaz.

"It’s only acceptable when the regime or any other group uses chemical warfare against us?" he wrote.

"The regime uses chemical warfare on a regular basis these days, and nobody bats an eye — yet when IS captures it from them and uses it against them it’s all of a sudden a huge problem?

"Fight them the way they fight you."

The Associated Press reported Thursday that Iraqi and American intelligence officials believe ISIS is hell-bent on ramping up a chemical weapons program with help of scientists in the territory that forms its so-called caliphate.

An Iraqi politician, citing intelligence reports, told the AP that ISIS has recruited chemical experts Chechnya, Southeast Asia and Iraq, including some who once worked for Saddam Hussein. NBC News has not been able to confirm that assessment.

It's a nightmare scenario, as illustrated by French Prime Minister Manuel Valls' warning to Parliament that bullets and bombs could be replaced by something less tangible but just as deadly.

"We must not rule anything out," Valls said.

But intelligence officials in Washington caution that intent is a far cry from capability, particularly when it comes to more sophisticated weapons like nerve gas.

"We know they are pursuing chemical weapons, but we haven't seen anything beyond mustard and chlorine," said Patrick Martin, an Iraq expert with the Institute for the Study of War, a military research think tank in Washington.

He said that even with mustard gas, the damage has been limited because it's essentially just added to warheads and mortars.

But does ISIS have the ability to develop weapons that would pose a threat to the West going forward?

Martin said that's still unclear.

"Mosul [seized by ISIS in June] has a university and that theoretically has the lab facilities to deal with this. The difficulty they may face is in obtaining the raw materials," he said.

Retired Lt. Gen Richard Zahner, a former top military intelligence officer in Iraq, said that while al Qaeda was never able to launch a chemical weapons program, ISIS has greater financial resources.

"Even a few competent scientists and engineers, given the right motivation and a few material resources, can produce hazardous industrial and weapons-specific chemicals in limited quantities," he told the AP.

And the U.S. military has noted that ISIS has been able to lure scientists to its side. In January, U.S. Central Command announced that an airstrike had killed Abu Mailk, a chemical expert who had worked under Saddah Hussein.

"His death is expected to temporarily degrade and disrupt the terrorist network and diminish ISIL's (ISIS') ability to potentially produce and use chemical weapons against innocent people," the statement said.

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Vaginal Tightening

WHAT IS VAGINAL TIGHTENING?

Often referred to as a “Designer Vagina”, many women choose to undergo vaginal surgery, or cosmetic gynecology, for various reasons. It can often be because they are dissatisfied with their genital appearance or would like to increase their sexual experience.

UNDERSTANDING VAGINAL TIGHTENING SURGERY

Vaginal tightening is particularly popular with new mums. Following childbirth, often the muscles of the vagina will lose elasticity and begin to sag. This relaxation of muscle tone, causing a loosening of the vaginal muscles and surrounding tissue, can also occur as women begin to age. Vaginal tightening surgery aims to assist with the muscle tone of the vagina by ensuring the muscles and supporting tissues are tightened.

The subject of vaginal surgery is no longer taboo meaning that women who feel uncomfortable with the appearance of their vagina, or who may have felt discomfort or even embarrassment have the opportunity to have it rectified with a procedure carried out by the very best cosmetic surgeons.

The procedure is carried out under general anaesthetic. You will also be required to stay overnight in either MYA’s amazing Fitzroy Hospital in Central London or a private hospital in the North.

VAGINAL TIGHTENING AFTERCARE

We use dissolvable stitches as standard for our vaginal tightening procedure. In the period immediately following your surgery, it is important to keep your incisions clean and dry. Approximately 7 to 14 days following the procedure you will notice any tenderness and swelling start to subside. We recommend wearing loose and comfortable clothing during this time, while sexual and physical activity is not recommended until at least 6 weeks after your post- op surgeon consultation.

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Khmer Rouge terror in Cambodia

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Vivisection is right, but it is nasty - and we must be brave enough to admit this

So, is it OK to sew kittens’ eyelids together to stop children going blind? All too often the arguments surrounding live-animal experimentation, aka vivisection, circle around the putative torments of genetically engineered rodents (which no one much cares about) and monstrous cruelties inflicted on our ape close-cousins (illegal here anyway). But the story that scientists at Cardiff University have been studying the way brains react to induced blindness by ‘modelling’ the condition in young cats has crystallised the arguments in a way that may end up being very helpful.

The British Union for the Abolition of Vivisection says that raising newborn kittens in total darkness and sewing shut the eyes of others is not only cruel but unnecessary. Firstly they say it is possible to study the effects of lazy-eye, or Ambylopia, in human volunteers (not, presumably, involving eyelid stitching). Worse, they say, cat brains and cat vision are fundamentally different to ours and it is hard to see how anything useful can be gained by this research. These experiments have been done before, many years ago, and we still do not have a cure.

I have always believed animal experimentation is not only right but a moral necessity. Put simply, without the use of animals in the lab we would not have modern medicine. We would have no cancer drugs, no effective antibiotics, no proper analgesics. Many surgical procedures would be impossible. Of course medicine could advance on an ad hoc basis using only humans as guinea pigs but that would require us to live in a totally alien ethical (not to mention legal) world.

I have always decried the antics of the loonies, the people who put letter bombs and faeces through the front doors of scientists, the activists who make working at any lab involving animal experimentation an exercise akin to being a member of the RUC in 1970s Ulster. These people do their cause no good.

And one of the main arguments against animal-rights lunacy is the sheer hypocrisy. Last year, according to the Home Office, 3.8m ‘procedures’ were carried out on animals in Britain in the name of science and medicine. There is no doubt that although some pain and suffering was caused, most of these animal recruits lead better lives, and certainly better deaths, than the estimated billion or so chickens, bullocks, pigs and lambs slaughtered in the same period to provide us with food.

Any argument about animal welfare in the lab is specious in a nation which still allows battery poultry farming. And yet it is not quite so simple as that. Even carnivores can see, for instance, that (say) squirting makeup into the eyes of rabbits in the name of human vanity is wrong even if we are happy to throw said bunny in the pot with some onions and red wine. So what about injecting chemotherapy or AIDS drugs into the veins of the same rabbit to see what happens? Better than the cosmetic tests, for sure, but on a very emotional level something feels very different about messing around with an animal to make us (maybe, one day) feel better and simply killing it to satiate our meat-hunger (of course as far as the rabbit is concerned this is angels-on-pinhead stuff).

What would help is a bit more honesty. All too often scientists and doctors lapse into euphemism and obfuscation when describing procedures that must be unendurable in a small number of cases. They often talk about ‘discomfort’, when they mean ‘screaming agony’ for example (in fact too many doctors are prone to do this with human patients. If this is something that is taught in medical school, please can it be stopped, now).

Yesterday Cardiff University put out a press release defending the kitten business which failed to acknowledge or even mention the grisly nature of the procedure and certainly did not address the reality that as far as the animals were concerned this would have been hugely unpleasant. In a world where 1600 animals (the vast bulk being chickens) are slaughtered every second for food, most in conditions that do not bear thinking about, it does seem facile to be considering the ‘rights’ of 31 Welsh kittens stumbling around their pens in the dark.

Facile, perhaps but necessary too. The scientists are, generally, right about this; research like this is needed. But they need to be made to keep reminding us why it is right and to keep justifying procedures that, without the watchful eye of the BUAV (and, yes, the loonies as well) would perhaps become so routine that no one would give them a moment’s thought. Animal experimentation is nasty. That does not make it wrong, but those of us who defend it must be brave enough to admit the truth, in all its grisly detail.

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In peace, women are feminists. In wars, they are cowards, trading sexual signals for sympathy and protection.

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Butea superba extract and other dietary supplements for divine sex

October 26, 2015

"Herbal Viagra" has been in the news recently. Are these products safe and/or effective?

The only genuine cures for erectile dysfunction are low intensity shockwave therapy and botox injections into the penis.

Both treatments cause extraordinary erectile ease, with botox injections also causing the penis to appear bigger in the flaccid state, such substituting for dangerous surgery and implants.

Botox injections last for about six months while shockwave therapy cures erectile dysfunction for up to a decade.

Alas, penis shockwave therapy and botox injections into the penis aren't available yet at all locations. This is why more and more men are using herbal performance boosters.

Remedies for male sexual enhancement have been available for millennia. The Ebers Papyrus, dating back to around 1600 BC, recommended topical application of baby crocodile hearts mixed with wood oil. A Sanskrit text written six centuries earlier suggested a man could visit 100 women after consuming a mixture of goat testes boiled in milk, sesame seeds, and the lard of a porpoise. Impotence, a nonspecific term that includes both erectile dysfunction and reduced libido, is clearly not a condition limited to modern civilization.

Erectile dysfunction affects an estimated18 million men in the United States, with a prevalence of 18.4% in men aged 20 years and older. Prevalence increases with age, ranging from 5% in men aged 20-39 years to 70% in men aged 70 years and older. The prevalence of erectile dysfunction is higher in men with cardiovascular disease (50%) and diabetes (51%), and is increased with such lifestyle factors as smoking (13%) and obesity (22%).

Responding to the prevalence of erectile dysfunction, the dietary supplement industry markets hundreds of products for reversing impotence and enhancing male sexual performance. Legally, dietary supplement labels cannot make medical claims, such as "for treatment of erectile dysfunction"; however, such claims as "to enhance sexual function" are permissible. An Internet search for "male sexual enhancement products" yielded more than 2 million hits, with websites offering products for purchase as well as information and testimonials.

Many of these products have been studied only in male rats, but the few studies in men have been small or poorly designed, limiting conclusions about efficacy and safety.

Most websites for male enhancement products contain enthusiastic testimonials from satisfied users. But the question remains of whether these products really work, despite the dearth of clinical evidence supporting the efficacy of the ingredients.

Unlabeled Ingredients

Some products for sexual enhancement augment sexual activity, but the labeled ingredients may not be the source of the effect. Of the 232 drug recalls by the US Food and Drug Administration (FDA) between 2007 and 2012—all for unlabeled drug ingredients—51% were dietary supplements. Of the dietary supplement products recalled, sexual enhancement products were the most commonly recalled (40%), followed by bodybuilding (31%) and weight-loss products (27%).[7] Of the 1560 Health Safety Alerts for dietary supplements issued by the FDA MedWatch and Health Canada between 2005 and 2013, 33% were for sexual enhancement products.

Unlabeled drugs in sexual enhancement products are frequently the prescription-only phosphodiesterase 5 (PDE5) inhibitors, such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®). With increasing frequency, the unlabeled drugs may be analogues of PDE5 inhibitors that have been modified slightly from the parent structures. These derivatives are not detected by routine laboratory screening, which reduces the risk for both detection by the FDA and lawsuits for patent infringement.

To date, more than 50 unapproved analogues of prescription PDE5 inhibitors have been identified.

Another study of 150 sexual enhancement products (eg, Evil Root, Herbal Stud, Magic Sex, ULTRASize) found 61% of the products were adulterated with PDE5 inhibitors: 27% with sildenafil, tadalafil, or vardenafil, and 34% with similar structural analogues. Among the adulterated products, 64% contained only one PDE5 inhibitor and 36% contained mixtures of two to four PDE5 drugs or analogues. The amounts of PDE5 inhibitor prescription medicines were higher than the maximum recommended dose in 25% of products.[8] Unlabeled yohimbine, flibanserin (Addyi™, which was recently approved by the FDA for female sexual dysfunction), phentolamine, DHEA, and testosterone also were found in some supplements.

Other researchers have found similarly adulterated products, many containing PDE5 inhibitor doses in excess of labeled amounts.

Safety Concerns

Although dietary supplements are marketed as "all natural" with implied safety, the available research suggests caution.

A recent survey indicates that cardiac symptoms were a frequent cause of emergency department visits among men aged 20-39 years taking sexual enhancement products.[14] The actual prevalence may be higher, because the presence of unlabeled PDE5 inhibitors may easily go unrecognized by clinicians. Common adverse effects of PDE5 inhibitors, such as flushing, lightheadedness, or dyspepsia, may be attributed to niacin and yohimbe, ingredients often found in sexual enhancement products. Profound hypoglycemia after ingestion of sexual enhancement products containing sildenafil and glyburide (Micronase® and others) also has been reported.

The covert addition of analogues of PDE5 inhibitors, which are not readily detectable by chemical screens, is particularly concerning. Although these chemical cousins of PDE5 inhibitors may retain the desired pharmacologic effect, none have been clinically tested for safety and toxicologic effects.

Obtaining dietary supplement products for sexual enhancement products has several perceived advantages. The purchase can be made discreetly, conveniently, and without a visit to a prescriber. Unlike drugs, dietary supplements are not required to be labeled with adverse effect or drug interaction information. Men taking prescription drugs, such as nitrates, may perceive dietary supplements for sexual enhancement as safe alternatives to contraindicated PDE5 inhibitors.

Clinicians should maintain a high degree of awareness for the potential for adverse effects of sexual enhancement products in men with unexplained cardiovascular symptoms. Patients who express interest in sexual enhancement supplements should be referred to their healthcare provider. Explain that even though a PDE5 inhibitor is not on the label, the supplement may have these ingredients added illegally without regard to patient safety. Patients should be warned of possible changes in vision and decreases in blood pressure, and the potentially dangerous combination of PDE5 inhibitors and nitrates that require medical advice.

PDE5 inhibitors are substrates of cytochrome P450 3A4 (CYP3A4). Monitoring is required to avoid an interaction with CYP3A4 inhibitor drugs, such as erythromycin, which may result in high PDE5 levels.

In summary, advise patients that dietary supplements for sexual enhancement fall into one of two categories: those that might be safe but do not work, and those that might work but are not safe.

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